Back Pain: Home Managements #3 - Pelvic tilt exercises

Introduction

Decreasing the lordosis ( curve of the low back ) is considered very important for minimizing the static low back pain. In order to decrease the curve of the low back, exercises and the concept of “Pelvic Tilt ” is advocated. If there is undesirable excessive lordosis , the “ Pelvic Tilt “ exercises are advised. The “ Pelvic Tilt “ exercises can also be termed as “ tuck – in – the – pelvis “ exercises. The patient is told to tighten his abdominal muscles and “ pinch “ the buttocks together. Now the patient gets the feeling of decreased lordosis. The Pelvic Tilt exercise can be easily taught when the patient lies in a supine position ( lying with the face upwards ). A firm surface is preferred to a soft surface. Once the Pelvic Tilt exercise is mastered in the supine position , it may be performed in the other positions also.

Exercises in lying postion

The patient lies in the supine position with the hips and knees flexed and the feet flat on the ground. The patient must be in a comfortable and relaxed position . In this position the Pelvic Tilt exercise is done in the following order.

The low back is pressed against the ground.

Once pressed against the ground it must be maintained in the same position till the whole exercise is over.

Keeping the low back pressed against the ground , the buttocks are raised slowly and gently from the ground. Care should be taken that the low back does not leave the floor.

Once the starting position is maintained , the first movement the patient has to do is “ pressing “ the low back flat to the floor . This may be facilitated by placing one’s hand or a folded towel between the low back and the floor and then ensuring that the hand or the folded towel remains pressed during the entire exercise . This movement is performed by the combined contraction of the abdominal and the buttocks muscles . The effect of this “ pressing “ is felt by the patient in his thigh muscles ( hamstrings and quadriceps ) and the hip muscles ( gluteal ) as well . That is , a “ squeezing “ sensation is felt in the muscles of the hips and the thighs. Placing the patient’s hand below the low back and having him press down on the hand may help him in understanding the exercise.

Once the low back is pressed against the ground , the patient tries to rotate the pelvis by raising the buttocks from the ground. This needs muscular effort . When the buttocks are being raised care should be taken that the low back remains pressed against the ground . This permits smooth pelvic tilting . This exercise not only flattens the lumbar lordosis ( curve of the low back ) but also helps to stretch the muscles of the low back. The patient holds the raised buttocks with the low back pressed against the ground for 5-6 seconds . Now slowly and gradually reversed back to the starting position . Repeat the exercise for 10 times .

Once the concept of pelvic tilt exercise is understood and achieved by the patient with the hips and knees fully flexed , the exercise may be done progressively with the legs gradually extended . Once the exercise can be done with the hips and knees fully extended the exercise can be done in the upright positions also. The flattening of the low back becomes increasingly more and more difficult as the legs become more and more extended .

Exercise in the lying position - Leg lift

The patient lies supine with the legs straight .ie. lie on back with back flat. Slowly lift the legs one feet above the floor , keeping the low back flat . Hold the legs on that position for five seconds. Then slowly and gradually bring the legs flat on the floor. Repeat the exercise ten times.

Exercise in the standing position

The patient stands against a wall with both feet slightly forward and the knees slightly flexed. Now the low back is pressed against the wall. Now the pelvis is pulled away from the wall while keeping the low back pressed to the wall. This position is held for 5 seconds. Slowly and gradually come back to the starting position. Repeat the exercise ten times. This exercise can be progressed further. As a progression the exercise is done bringing the feet closer to the wall step by step. Finally a stage may be reached in which the low back can be pressed against the wall with the feet at the wall.

Exercise in the standing position - Erect posture training

Place a weight upon the head of the patient while he is standing. With the weight on his head, he tries to push the weight upwards (trying to become taller). This decreases the curves of the neck and the low back. This position is held for five seconds. Then slowly and gently come back to the starting position. Repeat the exercise for ten times.

By repeating this exercise program several times, the concept of correct posture is understood by the patient and it will become a habit.

Exercise in kneeling position

The exercises in kneeling position has already been covered in one of my previous articles. you can refer it here.

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